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The tech world is buzzing about the rumor that Apple’s plans to build a car. They bought Beats a while back because they needed talent that knows how to make things that people will wear (e.g. a watch). And now they’re hiring talent from Tesla that knows how to build cars and software for cars.

Benedict Evans had a great post on this topic on Saturday where he offered lots of ideas on the risks and benefits of such a venture. Please go read it if you’re interested in this kind of stuff.

I wanted to point out two key points he made in the post here. From the post:

…can Apple create new value in the industry in the way that it did in phones? With the iPhone, Apple created a new price segment and (with Android following) made the phone industry’s revenue much bigger – the average price of a phone sold has more than doubled since 2007. But cars are, pretty obviously, more expensive than phones. Many people can find $400 for a better phone or, this year, a smart watch, if they’re persuaded that they really want one, but rather fewer can find an extra $40,000 for a better car, or to replace their car every two years instead of every 4 or 8. If you’re in the market for a $20,000 car, there is very little that anyone can do to a car that will put you in the market for a $60,000 car. Cars do not come out of discretionary spending.

This is an important point. The iPhone was such a success largely because, in reality, they created a new (high-end) category that didn’t exist before. The beauty of that high-end category is 1.) it’s actually a mass market category because most people can afford a iPhone — lots of people that make $50k a year have the exact same phone as people that make $30 million a year and 2.) people buy a new device every two years (that’s a pretty nice recurring revenue stream for a hardware business).

Generally, neither of these factors have existed in the car business (most people can’t afford high-end cars and the average driver replaces their car about every 10 years).

That said, these dynamics are changing a bit. Celebrities like Leonardo DiCaprio have been photographed driving around in a very affordable Prius (Frank Sinatra wouldn’t have been caught dead in a low-end car). And while it’s unlikely that the masses will start buying a new car every two years, it is becoming clear that fewer and fewer people are going to need to own their own car — both because of the astounding growth of on-demand rides and the coming emergence of self-driving cars.

Benedict writes about this later in the post.

…self-driving cars might support both an on-demand model and an AirBnB model for cars – does your car drop you off at work and then roll off into the city to earn you some extra money driving other people around? Would people want to do that? Would that reduce the opportunity for ‘dedicated’ on-demand vehicles? Who knows. Of course, it’s also possible that self-driving technology, said to be a decade away now, will remain a decade away indefinitely, as so many other AI projects have done.

In short, on-demand rides, shared self-driving cars and artificial intelligence are going to lead to massive changes in the way we get around and the way we manage our own personal transportation and the things that we do while we’re travelling. And all of it — I mean all of it — is going to be driven by software that will become a large part of our day-to-day routine. Apple has to be in the middle of that. Apple has to make a car.

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A couple weeks ago I was listening to a panel discussion with a bunch of venture capitalists and someone (I can’t remember who) made the point that the value of so many of today’s web services comes down to one question: “who owns the data?”

For example, while Uber has some nice UI/UX, the real reason they’re so valuable is that they own the data. For them, the data is knowing where all the cars are located. I go to Uber because I can quickly locate and communicate with the drivers in my area. I like the app, but the real value is the location data. Same thing with AirBnB. It’s not the app, it’s the data they have on all the properties that I’d like to rent.

This is an enormous step forward for the integration of patient captured health data with provider captured health data. It’s awesome news.

But as all of this finally starts to come together, it begs the question: who owns the data?

Or, at scale, which company benefits the most from all of this data floating around?

Stanford? Withings? Fitbit? Apple? Epic?

Well, Stanford is very local, and isn’t terribly focused on data collection, so it’s probably not them.

Withings, Fitbit and other device makers contribute a relatively small part of human health data so at least for now they’re not going to own a large piece of the data pie.

Apple still only owns well under half of U.S. smart phone market share — and that number is expected to shrink. And they own even less of the market share of the chronically ill patient segment that can really benefit from this kind of data exchange.

So that leaves Epic, the 30-year-old health IT vendor that currently owns a medical record on well over half of the U.S. population. They have long-term contracts with large providers and (presumably) a long-term contract with Apple and will likely cut deals with Android and other smartphone operating systems in the near future.

In short, more than anyone else, Epic will own the data.

But this raises all sorts of new and interesting questions and conflicts. Will Stanford allow Epic to share its patient records with other Epic providers? Will Stanford allow Epic to share its patient records with other health IT companies? Will Epic allow Stanford patient records to be shared with other health IT companies? Will Apple allow Epic to share data captured from an Apple device with data captured from an Android device?

As I’ve written before, it seems to me that in the long-term, the answer is a Mint.com for Healthcare, where the patient truly owns the data. But in the meantime, the question of “who owns the data?” will be watched closely by investors, app makers, providers, health IT companies and patients. It’s going to be fascinating to watch this play out.

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Several years ago when I was working with an e-commerce company we came up with a framework for how to grow transactional shopping revenue.

We called it “the Box”.

The idea was to get shoppers into the box (acquire new users and get them to come back to our sites regularly). And then, once they were in “the box”, to make good things happen (get them to buy lots of stuff).

We setup two separate teams: one team was focused on driving traffic and the other was focused on converting that traffic into dollars.

The “traffic driving” team didn’t worry about shopping conversions and the “conversion” team didn’t worry about driving traffic. We put the teams in silos and told them to focus on their goals. The thinking was that if both teams did their job, overall revenue would grow.

The beauty of the framework was that when weekly revenue grew, we could very easily determine who deserved credit. Was the increase caused by something that the traffic driving team did or something that the conversion team did? Very rarely was it both. Neither team could hide behind another’s success. We could easily identify the initiatives that we’re contributing to overall revenue and those that weren’t. It seemed like a great model.

But we quickly saw that the structure we setup caused some problems.

The traffic driving team, in an effort to drive traffic (as opposed to revenue), found some quick, easy and suboptimal ways to drive traffic to our sites. For example, they’d email millions of users with an offer from a high-end car company. The response rate would be great and traffic grew, but nobody bought (low conversions). Users just clicked around and looked at the cars because they were interesting. Most weren’t planning to buy, or if they were they were planning to buy offline.

At the same time, the conversion team put brands that converted well (such as Target and Wal-Mart) front and center on our websites. While those brands did convert well, they produced small average order sizes and didn’t pay us a significant commission. Combine that with the fact that the traffic driving team wasn’t pushing shoppers to the offers that the conversion team was promoting and we quickly found that our user experience was disjointed.

It became clear that we couldn’t have our teams operating in silos. To maximize revenue, they had to work together. They had to collaborate. They had to do more than just their own job.

This initiative underscores the challenges around siloed teams and metrics. When high performing people are given clear objectives with quantifiable metrics attached to them, they’ll very often accomplish those objectives. And there will very often be unintended consequences from that accomplishment.

All of that said, even after that experience, I still strongly believe that managers must create clear, measurable metrics for every employee in the organization that only that employee can control. It’s a crucial part of an accountable, high performing organization.

But at the same time managers need to closely monitor whether or not those siloed metrics are positively or negatively impacting the overall health of the business. Setting up a framework where individuals and teams are focused on producing impactful work week to week is the (relatively) easy part. Getting multiple teams focused on snyergistic activities that add to the overall value of the business is much more difficult. And much more important.

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Vince Kuraltis, a healthcare IT consultant, tweeted this the other day:

He’s referring to the fact that each of his healthcare providers has a different patient portal run by a different IT vendor with a separate log-in and separate data and functionality. Providers are launching patient portals to allow patients to view clinical records, refill prescriptions, email their providers, etc. The point is to better engage patients in their health. It’s a very important effort. But as Vince points out, the disconnected and fragmented experience can be really frustrating for patients.

This challenge is quite similar to the challenge that banking faced years ago as they took their customer experience online. Personally, I have accounts with Bank of America, Fidelity, eTrade, American Express and a few others. All of these accounts have separate web “portals” with separate log-ins. That’s frustrating. But not really. Because I spend very little time on any of them. Most of my time is spent on Mint.com, where I’ve integrated all of these accounts into one place. From there, I can view all of my transactions and balances, track expenses and create budgets. It’s great. It’s has award-winning UI/UX and everything is one place.

Mint has taken the bottom-up approach. They started by building a platform for the consumer. And the consumer allows data from multiple vendors to be integrated into their account.

Healthcare needs a similar bottom-up approach.

We need a portal that allows us to integrate all of the data collected on us from our dentist that runs Dentrix software, our primary care doctor that runs eClinicalWorks, our gastroenterologist that runs Epic, our wife’s OBGYN that runs Cerner and our child’s pediatrician that runs Allscripps. All of that data could be neatly compiled into a really user-friendly website (and app), similar to Mint. If I move to a new area and select a new primary care provider, she could simply tap into my account and view all of my scans, test results, prescriptions, etc.

Why should Bank of America freely pass data they’ve captured about me to Fidelity (a competitor)? They don’t want to do this because they want me to stay with them, not make it easy to use other vendors. Why is that any different than asking UCLA Medical Center to pass my data to USC Medical Center? It would be nice if they did, but I’m not sure it’s the government’s role to force them to do something that might not be aligned with their competitive interests.

The bottom-up, consumer led approach circumvents this entire conflict. We need a patient portal that starts with the patient, that allows providers (and their EMR vendors) to plug-in (if they’d like). Not the other way around.

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Fred Wilson, the well-known venture capitalist, wrote a blog post last week with some technology predictions for 2015. He touched briefly on healthcare:

the health care sector will start to feel the pressure of real patient centered healthcare brought on by the trifecta of the smartphone becoming the EMR, patients treating patients (p2p medicine), and real market economies entering health care (people paying for their own healthcare). this is a megatrend that will take decades to fully play out but we will see the start of it in 2015.

All of these predictions are spot on, of course — the patient will become more and more in control of their care.

But if you talk to the people on the ground you’ll find that these things aren’t really being talked about or worked on at the provider level.

Case in point, John Halamka, the CIO of Beth Israel Deaconess Medical Center, considered one of the most innovative thought leaders in healthcare technology, wrote a post the other day reviewing some of the key health IT issues on his plate during 2014 with some predictions for 2015. In short, he’s focused on implementing software that will facilitate accountable care workflows inspired the Affordable Care Act; meeting government electronic medical record adoption standards (Meaningful Use); and complying with government regulations around the protection and security of personal health information (HIPAA).

These are very different things than the things that guys like Fred Wilson are thinking and talking about. Venture Capitalists are completely focused on the patient. Real world healthcare operators (CIOs) are primarily focused on meeting government requirements.

This disconnect — or, at least, that degree of separation from the patient — isn’t the fault of CIOs; they have no choice but to focus on the urgent and intense demands coming from the government to ensure that they continue to receive government incentives and avoid penalties.

Venture Capitalists are focused on where healthcare technology and the patient are going (e.g. where the money will be). Given the intense regulation, health system CIOs don’t have that luxury.

All of that said, for the most part, I think government intervention into healthcare IT has been a good thing. Healthcare execs are totally focused on efforts to increase quality and reduce cost. Most stakeholders (providers, payers, regulators) have gotten behind value based care payment models — the winds are all going in that direction. And providers are now fully onboard with electronic medical record adoption (at last check ~80% of providers are using them). None of this could’ve happened this quickly without government intervention.

But now that the groundwork is laid, it’s time for the government to back off a bit and let the market start to drive more of the innovation in healthcare IT. Providers need the room to move their businesses and IT investments away from meeting the requirements of restricting, top-down government initiatives and closer to providing tools that are centered-on and built around the needs and desires of the patient.

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The other day I was talking to a founder of a B2B software startup about how hard it is for big companies to buy things. Even at a super low price point (a couple hundred bucks a month) software purchases still have to go through a litany of approvals.

I was telling her how almost exactly two years ago I wrote a post titled, Individual Employee Budgets, where I predicted that employees would have their own discretionary budgets that could be used to buy things that would make them more productive and profitable employees. With the growing trend towards the consumerization of enterprise and the ability for anyone in their basement to build and distribute a great productivity application to millions of employees, individual budgets, I thought, would be a requirement for companies to succeed and retain employees. For smaller purchases, traditional procurement eventually has to get out of the way.

I still believe this will happen, but it’s moving much slower than I predicted.

That said, two years after writing that post, when I think about the software I use to get my job done, much of it is ‘consumerized’. That is, it’s sold directly to me and in order for me to use it my company doesn’t have to go through a painful procurement process. Software like Wunderlist, Google Maps, TripIt, Sunrise, Feedly, Evernote and Google Docs, to name a few. There are only a couple of applications that I use that were procured through a traditional procurement process — and most of those aren’t as useful or as easy to use as those that I procured myself. Self-service software has to be really, really good as the switching costs are near zero.

It’s disappointing that the way companies buy hasn’t become more flexible as enterprise software has become more consumerized and easy to procure. Employees are ready for self-service productivity tools and software makers are ready to build and distribute them. The only thing we’re waiting for is for big buyers to let it happen.

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Lots of people that know me know that I’m huge fan of Bill Belichick, the coach of the New England Patriots. The thing I like about him more than anything else is that he never, ever makes excuses. When the Patriots lose a close game, the media will ask him about the weather, the referees, the tough schedule, the rules, the player injuries, you name it. And he never acknowledges any of it. He only talks about the things that his team can control. As a result, he’s the winningest coach of the last decade. He obsesses about what he can control and ignores everything else.

That is the exact approach people should take at work — especially when negotiating a deal. You can’t control the prospect, the prospect’s attorneys, the bad economy, your product capabilities, the law, or your executive team. You can only control your own actions. And when you fully take that approach, you’ll find that your energy won’t go outwards towards things you can’t control, but will instead go inwards towards things that you can. That’s how you get better. That’s how you win.

I recently finished a long, painful and frustrating 3 month negotiation. Thinking back on it, I’m tempted to blame the other side or blame other factors for why it was so long and so frustrating. But that’s not helpful because I can’t control any of that. I can only control what I do and try to do it better.

So with Bill Belicheck in mind, here are seven tactical things (that I can control) that I’ll do better next time:

1. Never assume the deal is done. Make sure you have asked and asked and asked about the other side’s approval process. More often than not someone is going to come along to do one final review of your deal. Document their process and track to it.

2. When you’ve created urgency, continuously validate that the other side values that urgency. Over a long negotiation they may not.

3. In addition to urgency, throughout the negotiation continuously reinforce your value and why the other side should want to partner with you. Don’t get too caught up in the weeds and the specifics of the deal and neglect to remind the other side why they wanted to partner in the first place.

4. Have a ‘time and energy walk away point’. Most negotiators know the concept of BATNA (best alternative to a negotiated agreement) but don’t forget to include your own time and energy in that calculation. Take this really seriously. Focusing on a deal that is too time consuming has an exponentially negative effect. You can dig yourself deeper because you’re not focusing on other opportunities and you lose your leverage (you need the deal more now because you have fewer options now because you’ve been too focused on this one deal).

5. When you’re down to the last few items, setup a recurring daily meeting with the other side until it gets done. It’s amazing how you can lose weeks if you don’t do this. People get busy and each side may use time lags to build leverage.

6. When things get ugly, negotiate in person. Your situation will improve 10x faster in person than it will over the phone.

7. Bring in other people. I tend to be a lone wolf when it comes to these things. It’s better to have multiple personalities involved. Two people are harder to read than one and the other person will always think of things you haven’t.

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Most readers know that an EMR (electronic medical record) is the back-end software that runs a healthcare organization (think ERP for healthcare). EMRs have been around for a while. Recently most large hospitals and health systems have begun building out the patient-facing version of their EMR; allowing patients to communicate electronically with their doctors, refill prescriptions, schedule appointments, view clinical information, etc.

I’ve written at length about the differences between B2B software and B2C software and how B2B software is generally not very good (particularly from a usability perspective). And it’s not very good simply because it can get away with not being very good. B2B companies really just need a good salesperson that can lock-in long-term contracts to be successful.

B2C companies, on the other hand, need an incredible product to be successful. If your user experience isn’t flawless, you cannot survive in the B2C space. The switching costs for consumers are near zero — the user experience must be incredible. Product is much more important than distribution.

Applying this to healthcare, if you’re a hospital and your EMR is hard to use, your employees will still use it because they have to.

But if your patient portal is bad you will lose patients instantly. It’s too easy for patients to switch to something else.

The Healthcare Information and Management Systems Society (HIMSS) published a good report last month talking about patient portals. They noted that despite the difficulty of building a wonderful online consumer experience and the totally different skill set required to execute on it, 80% of hospitals surveyed chose their patient portal vendor simply because it was the same vendor that provides their EMR (the top three portals are made by Epic, Cerner and McKesson). All of these vendors have been building B2B enterprise software systems for more than 30 years. They’re all wonderful companies. But they have no idea how to build a patient facing product. Their management, engineering talent, sales force, culture and DNA is all about B2B. They have almost no chance of building a world class consumer product. That’s not a knock on these companies, it’s just reality. You can’t be really good at both.

As we transition to a world where the patient is in the drivers seat, exposing patients to old fashioned enterprise software code is a terrible idea. Hospitals shouldn’t let a piece of software touch their customers unless it’s been vetted and tested fully and it’s clear that patients love it. If you check out the satisfaction scores for most patient portal apps you’ll find that most patients despise them (one of them had 2,000 reviews in the iOS app store and more than 1,500 of them were only 1 star).

Patients are becoming consumers. They want slick, easy, mobile, beautiful, simple and seamless web experiences. If the software that touches patients doesn’t give them that they’re going to go somewhere that does.

Now, in defense of these hospitals let it be known that there aren’t a lot of great consumer-focused software companies building out patient portals. So in the short term they might have no choice. But I’d encourage CIOs that are making patient portal investments to consider the consumer, and to cautiously enter into flexible and short term contracts with these patient portal vendors.

You wouldn’t buy groceries from the company that washes your car and you shouldn’t buy a patient portal from the company that built your EMR.

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When I interview job candidates, one of the questions I almost always ask them is: “If I was going to start doing your job tomorrow, tell me something that you know that would make me better at the job that you didn’t know before you started?” You can learn a lot from the answers you get.

With that in mind, 2014 marks the 15th year that I’ve been a working “professional”. During that time I’ve worked with start-ups in e-commerce, real estate, finance, biotech and healthcare. I’ve been in some fast-paced and really competitive environments. And I’ve made a lot of mistakes and learned a lot of stuff that I didn’t know before I started.

So I thought I’d put together a list of 15 key things that I’ve learned (one for each year) that have helped make me successful. Specifically, these are things that I didn’t know or appreciate before I got into the real world. Here we go:

1. It’s a grind. Work is hard and painful and complicated. If it’s not a grind then you’re probably not trying hard enough. Get comfortable being uncomfortable.

2. Be candid. Try to facilitate a work environment where if someone is doing well you tell them instantly and if someone is not doing well you tell them instantly. Get used to being honest and upfront about what’s working and what’s not. This is only hard when your culture isn’t used to it. Force people to get used to being candid.

3. Assume that most people are lazy and incompetent and what you want from them isn’t important to them. This definitely isn’t always true, but you’re better off assuming it is.

4. There’s no such thing as sales. There are just two parties trying to do something good for themselves and their families. Everything is driven by self interest. Never defer to a buyer. They’re not doing you a favor, they’re getting something and you’re getting something. You are equals. Act like it.

5. Cannibalize yourself. Too long to describe here. I wrote a post on this a while back. But in short, put yourself out of business before someone else does.

6. Always do the the right thing. Don’t take credit for other people’s work. Publicly recognize your peers that are doing good things. Share your ideas and insights with other people. Don’t go over your boss’s head. Help people. Don’t one-up people. Do the right thing. Don’t think about this from an ethical perspective. That might make it too blurry. Think of it practically. I’m telling you with 100 percent certainty, it might not feel like it at the time, but I promise you that doing the right thing is better for you in the long term.

7. The worst trait in a colleague or a boss is insecurity. Avoid insecure people. And avoid insecure managers like they have a contagious disease.

8. Manage yourself harder than your manager manages you. Don’t even make it close. If your performance is being actively managed by your manager you are losing. Get in front of it. Innovate on how you should be measured and developed and managed. Never fall behind on this.

9. Try to find the trifecta job. Something that you’re good at, something that someone will pay for, and something that you love.

10. Firing someone is almost always the best thing for the person being fired. I’ve worked in a lot of cut-throat environments and I’ve seen a lot of people get fired and I’ve fired a lot of people. Not once can I point to a time where it wasn’t the best thing for the person and the company. Both sides always wind up in a better place. And be respectful to people that get fired. Someone that is awful at their job could easily be a top performer somewhere else and someone that is awesome at their job could easily be a bottom performer somewhere else. It’s all about fit.

11. Credentials are meaningless. I’ve worked right alongside several Harvard Business School grads and several software engineers from Apple. There’s absolutely no correlation between success at work and these credentials.

12. Hiring good people is really difficult. The traits I look for are grit, adaptability, curiosity and humility. These things are almost impossible to measure in a traditional interview.

13. Admit when you’re wrong. If you’re the kind of person that can’t admit when you’re wrong, please stop being that kind of person. Being wrong and admitting it 1,000 times is way, way better than being wrong one time and not admitting it. Embrace being wrong.

14. Be a lynchpin. Seth Godin has a book on this that you should read. But the point is that you should run as fast as you can to be a completely critical piece of your organization. If you’re not that, then try harder or move on to somewhere where you can be.

15. Always think in terms of metrics. Whenever you think about an initiative or a new role or a team structure, think of what metrics it will impact. If what you do every day doesn’t impact your company’s key metrics then you’re not a lynchpin.

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I’ve always felt that if you’re challenging a buyer, providing insights, selling efficiently and helping them understand a problem, the psychological side will sort itself out. But the fact is there’s absolutely a psychological impact that comes with your approach (hopefully a positive one).

I thought about all of this a few weeks ago while sitting on a plane reading Pitch Anything by Oren Klaff. Early on in the book he talks about the evolution of the human brain. There are three fundamental layers of the brain that have been built on top of one another as the human species has evolved. We started with the ‘crocodile brain’ and then added the mid-brain and then added the neocortex part of the brain.

The first and most fundamental part of our brain is the crocodile brain. This is basically the thing that keeps us alive. We use it to recognize danger and threats. It’s an extremely simple part of our brain. It can’t think critically and it can’t reason. Its only purpose is to protect us.

When you walk into a room to pitch something this is the part of the brain that your buyer is using. The buyer’s crocodile brain is on high alert. The buyer is asking themselves questions like: Is this person going to hurt me? Is this person trying to fool me? Is buying this product going to get me fired? Should I trust this person?

In that first interaction, these are the things that the buyer cares about. That’s their focus.

The problem for you as a seller is that when you’re pitching, you’re not using your crocodile brain. You’re using your neocortex brain — the most sophisticated part of your brain. You’re thinking critically. You’re giving insights. You’re talking about details. You’re probably showing detailed charts and graphs. You’re probing, engaging and being thoughtful.

But the crocodile part of the brain doesn’t understand the neocortex part of the brain. So you’re completely missing the mark. You’re speaking different languages. You might as well be speaking German to someone that only speaks English. Being smart, in this case, is actually hurting you.

As I said, I don’t like diving into the psychology of sales, but there are some good lessons in here.

This insight is a great reminder that when you’re meeting someone for the first time, talk to their crocodile brain. Keep it short, simple, concise and clear and don’t try to do too much. Save the fancy charts and data tables for next time. Nobody is going to seriously engage with you until you have credibility and some level of trust. That’s the goal of the first meeting: build credibility and trust. And try to get to the next step of your education process. But forget about complex models and detailed financial analysis. They won’t listen to it, they won’t digest it and they definitely won’t believe it. Save all of that for the next meeting, after you’ve satisfied their crocodile brain.

Also, on the topic of keeping your presentation short, Klaff points out that in 1953 when James Watson and Francis Crick introduced the double-helix DNA structure (e.g. the secret of life), the presentation that earned them the Nobel Prize, was five minutes long. That’s right, the most important scientific discovery of our time was pitched in five minutes.

Regardless of what you’re selling, something tells me that in your next meeting you don’t need to be pitching for the full hour.